Chapter 2 The WellBeing of the Rescuer Chapter
Chapter 2 The Well-Being of the Rescuer
Chapter 2: The Well-Being of the Rescuer Objectives (1 of 6) • List possible emotional reactions that the rescuer may experience when faced with trauma, illness, death, and dying. • Discuss the possible reactions that a family member may exhibit when confronted with death and dying. • Recognize the signs and symptoms of critical incident stress. 2
Chapter 2: The Well-Being of the Rescuer Objectives (2 of 6) • State possible steps that the rescuer may take to help reduce/alleviate stress. • Explain the need to determine scene safety. 3
Chapter 2: The Well-Being of the Rescuer Objectives (3 of 6) • List the personal protective equipment necessary for each of the following situations: – Hazardous materials – Rescue operations – Exposure to bloodborne pathogens – Exposure to airborne pathogens 4
Chapter 2: The Well-Being of the Rescuer Objectives (4 of 6) • Discuss the ways in which the body produces, loses, and conserves heat, and how they are important in adjusting to cold and hot weather. • List ways in which the body adapts to high altitude. • List the signs and symptoms due to rapid, short-term exposure to high altitude. 5
Chapter 2: The Well-Being of the Rescuer Objectives (5 of 6) • Discuss the principles and practical methods of dressing for cold and hot weather. • Discuss the importance of good nutrition and adequate fluid supply when working in the outdoor environment. • List ways to secure safe water in the outdoors. • List components of a good exercise program. 6
Chapter 2: The Well-Being of the Rescuer Objectives (6 of 6) • List the factors to be taken into consideration when it is necessary to adapt to the outdoor environment. • Given a scenario with potential infectious exposure, the rescuer will use appropriate personal protective equipment. At the completion of the scenario, the rescuer will properly remove and discard the protective garments. 7
Chapter 2: The Well-Being of the Rescuer Adapting to the Outdoor Environment • The health, safety, and well being of all rescuers are vital to any rescue operation. • The human body needs a constant supply of oxygen, a stable internal body temperature, water, food, and the will to survive. 8
Chapter 2: The Well-Being of the Rescuer Oxygen • Circulation carries oxygen (O 2) to cells and CO 2 back to lungs. • Numerous causes can lead to interruption of O 2 to tissues. 9
Chapter 2: The Well-Being of the Rescuer High Altitude • Acclimatization • Hyperventilation • Hypoxia 10
Chapter 2: The Well-Being of the Rescuer Regulation of Body Temperature • The human body is able to generate and lose heat to regulate its core temperature. • Heat loss processes include: – Conduction – Convection – Evaporation – Radiation – Respiration 11
Chapter 2: The Well-Being of the Rescuer Adjusting to Weather Extremes • Decrease/increase heat loss • Decrease/increase heat gain • Clothing systems 12
Chapter 2: The Well-Being of the Rescuer Food and Water • Nutrition and hydration – Daily caloric requirement – Daily water requirement – Effects of exercise and altitude • Water purification 13
Chapter 2: The Well-Being of the Rescuer Physical Fitness • Includes: – Motor fitness – Cardiovascular fitness • Aerobic capacity • Parts of a well-balanced training program 14
Chapter 2: The Well-Being of the Rescuer Emotional Aspects • Challenging incidents • Emotional stress • Professional approach 15
Chapter 2: The Well-Being of the Rescuer Death and Dying (1 of 2) • Changes in society have altered people’s attitudes toward death. • Few people have actually witnessed a death. • Life expectancy has increased. 16
Chapter 2: The Well-Being of the Rescuer Death and Dying (2 of 2) • Death is something you will have to face. • Coming to grips with death is part of delivering care. 17
Chapter 2: The Well-Being of the Rescuer Physical Signs of Death • Death is the absence of circulatory and respiratory function. • If the body is still warm, initiate care. • If hypothermia is present, initiate care. 18
Chapter 2: The Well-Being of the Rescuer Presumptive Signs of Death • • Unresponsive to painful stimuli Lack of pulse or heartbeat Absence of breath sounds No deep tendon or corneal reflexes Absence of eye movement No systolic blood pressure Profound cyanosis Decreased body temperature 19
Chapter 2: The Well-Being of the Rescuer Definitive Signs of Death • Obvious mortal injury • Dependent lividity • Rigor mortis • Putrefaction (decomposition of body) 20
Chapter 2: The Well-Being of the Rescuer Medical Examiner Cases • DOA • Unknown cause of death • Suicide • Violent death • Poisoning • Accidents • Suspicion of criminal action 21
Chapter 2: The Well-Being of the Rescuer The Grieving Process 1. Denial: Refusal to accept 2. Anger: Blaming others 3. Bargaining: Promising to change 4. Depression: Openly expressing grief 5. Acceptance: The simple “yes” 22
Chapter 2: The Well-Being of the Rescuer What Can the Rescuer Do? • Provide gentle, caring support. • Make helpful statements and comments. • Be yourself and be sincere. • Understand that grief is a process that must be worked through. 23
Chapter 2: The Well-Being of the Rescuer Approach to the Dying, Critically Ill, or Injured Patient • Anxiety • Guilt • Pain and fear • Mental health problems • Anger and hostility • Depression • Dependency • Receiving unrelated bad news 24
Chapter 2: The Well-Being of the Rescuer Caring for Critically Ill and Injured Patients (1 of 2) • Avoid sad and grim comments. • Orient the patient. • Be honest. 25
Chapter 2: The Well-Being of the Rescuer Caring for Critically Ill and Injured Patients (2 of 2) • Acknowledge the seriousness of the condition. • Allow for hope. • Locate and notify family members. 26
Chapter 2: The Well-Being of the Rescuer Injured and Critically Ill Children • Basic treatments remain the same. • Consider differences between children and adults. • Being accompanied by a relative may relieve the child’s anxiety. 27
Chapter 2: The Well-Being of the Rescuer Dealing with the Death of a Child • A child’s death is a tragic event for both rescuers and the family. • How the family deals with the death will affect its stability. • Rescuers are responsible for helping the family. 28
Chapter 2: The Well-Being of the Rescuer Helping the Family • Acknowledge the fact of the child’s death in a private place. • Tell the parents that they may see their child. • Do not overload the parents with information. • Parents should be encouraged to talk about their feelings. 29
Chapter 2: The Well-Being of the Rescuer Stressful Situations • Mass-casualty situations • Infant and child trauma • Amputations • Abuse • Death or injury of a coworker 30
Chapter 2: The Well-Being of the Rescuer Factors Affecting Patient Reactions to Stressful Situations • Fear of medical personnel • Medication reactions • Alcohol/substance abuse • Nutritional status • Chronic diseases • Age • Guilt feelings • Mental disorders 31
Chapter 2: The Well-Being of the Rescuer Uncertain Situations • When uncertain if the patient’s condition is an emergency, contact medical control. • Minor symptoms may be early signs of severe illness or injury. • When in doubt, err on the side of caution. 32
Chapter 2: The Well-Being of the Rescuer Stress Warning Signs and the Work Environment • Emergency care is a high-stress job. – Understand the causes of stress. – Prevent stress from negatively affecting you. 33
Chapter 2: The Well-Being of the Rescuer Physiologic Manifestations of the Fight-or-Flight Response (1 of 2) • Rise in respirations and pulse • Increase in blood pressure • Cool, clammy skin • Dilated pupils 34
Chapter 2: The Well-Being of the Rescuer Physiologic Manifestations of the Fight-or-Flight Response (2 of 2) • Tensed muscles • Increased blood glucose levels • Perspiration • Decreased circulation to GI tract 35
Chapter 2: The Well-Being of the Rescuer Physical Symptoms of Stress • Fatigue • Changes in appetite • Headaches • Insomnia/hypersomnia • Irritability 36
Chapter 2: The Well-Being of the Rescuer Psychological Reactions to Stress • Fear • Depression • Anger • Frustration 37
Chapter 2: The Well-Being of the Rescuer Critical Incidents • Mass-casualty incidents • Traumatic injury or death of a child • Automobile crash caused by EMS personnel • Serious injury or death of a coworker 38
Chapter 2: The Well-Being of the Rescuer Signs and Symptoms of Posttraumatic Stress Disorder • Depression • Startled reactions • Flashback phenomena • Amnesia of event 39
Chapter 2: The Well-Being of the Rescuer Critical Incident Stress Management (CISM) • Confronts responses to critical incidents and defuses them • Process designed to help rescuers deal with responses to critical incidents • Composed of trained peers and mental health professionals 40
Chapter 2: The Well-Being of the Rescuer Stress Management • There are positive and negative ways of handling stress. • Stress is unavoidable. • Understand the effects of stress. • Find balance in life. 41
Chapter 2: The Well-Being of the Rescuer Stress and Lifestyles • Be aware of burnout. • Maintain physical and mental health. 42
Chapter 2: The Well-Being of the Rescuer Stress and Nutrition • The job requires high energy food. • Eat frequent small meals. • Avoid overeating. 43
Chapter 2: The Well-Being of the Rescuer Benefits of Exercise • Enhances ability to handle stress • Increases performance 44
Chapter 2: The Well-Being of the Rescuer Balancing Work, Family, and Health • Find time to relax. • Others may not understand stress. 45
Chapter 2: The Well-Being of the Rescuer Critical Incident Stress Debriefing (CISD) (1 of 2) • Held within 24 to 72 hours of a major incident • All information is confidential. • CISD leaders and mental health personnel offer suggestions for overcoming the stress. 46
Chapter 2: The Well-Being of the Rescuer Critical Incident Stress Debriefing (CISD) (2 of 2) • Designed to accelerate normal recovery • International Critical Incident Stress Foundation, Inc. – (410) 313 -2473 – (410) 750 -9600 – Icisf@erols. com 47
Chapter 2: The Well-Being of the Rescuer Components of CISM System (1 of 2) • Preincident stress education • On-scene peer support • Disaster support services • Defusings 48
Chapter 2: The Well-Being of the Rescuer Components of CISM System (2 of 2) • CISD • Follow-up services • Spouse and family support • Community outreach programs • Other wellness programs 49
Chapter 2: The Well-Being of the Rescuer Scene Safety and Personal Protection • Protection is important and should be automatic. • Avoid secondary accidents that compromise rescue. • Anticipate hazards. • Place crossed skis above site. 50
Chapter 2: The Well-Being of the Rescuer Communicable Diseases • A disease transmitted from one person to another • Minimize risk of contracting disease with proper protection. 51
Chapter 2: The Well-Being of the Rescuer Routes of Transmission • Direct – Being sneezed on • Vector-borne – Bitten by a tick • Vehicle (indirect) • Airborne – Touching contaminated linen – Inhaling contaminated droplets 52
Chapter 2: The Well-Being of the Rescuer Common Terms (1 of 2) • Exposure – Contact with blood, bodily fluids, tissues, or airborne droplets directly or indirectly • Universal precautions – Protective measures developed by the CDC to prevent workers from direct or indirect contact with germs 53
Chapter 2: The Well-Being of the Rescuer Common Terms (2 of 2) • Body substance isolation (BSI) – Infection control techniques based on the assumption that all bodily fluids are infectious • Exposure control plan – Comprehensive plan to reduce the risk of exposure 54
Chapter 2: The Well-Being of the Rescuer Body Substance Isolation (BSI) • Handwashing • Gloves and eye protection • Mask and gowns • Patient care equipment • Bedding • Disposal and cleanup 55
Chapter 2: The Well-Being of the Rescuer Other Risks • Latex allergy – 10% of all health care workers • Hazardous materials (Haz. Mat) – Identified by colored diamond shaped labels – Notify 9 -1 -1 of Haz. Mat situations. – Collect MSDS. 56
Chapter 2: The Well-Being of the Rescuer Scene Hazards • Hazardous materials – Never approach an object marked with placards. • Electricity – Do not touch downed power lines. – Recognize the signs before a lightning strike. • Fire – Do not approach unless you are trained and protected. 57
Chapter 2: The Well-Being of the Rescuer Reducing Risk of Infection • Follow the exposure control plan. • Always follow BSI precautions. • Always use a barrier between you and the patient. • Always wash your hands. • Make sure all immunizations are current. 58
Chapter 2: The Well-Being of the Rescuer Dealing with the Injured and Ill • Introduce yourself. • Obtain consent. – Parental consent is needed for children. • Allow for refusal. • Consider your statements carefully. • Strive for a calm, professional demeanor. 59
Chapter 2: The Well-Being of the Rescuer Immunizations • Recommended: – Tetanus-diphtheria boosters (every 10 years) – Measles, mumps, rubella (MMR) – Influenza vaccine (yearly) – Hepatitis B vaccine 60
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